Adrianne has taught high school and college biology and has a master's degree in cancer biology.

In this lesson we are going to review pulse and then discuss what a pulse deficit is. We will also look at the causes of pulse deficit and examine how they cause the condition to occur.

The Pulse

You've just finished a long day at work and are pumped up about starting your new cardio workout. About an hour into your workout, you need to check your heart rate to make sure you've reached your desired heart rate. The easiest way to determine your heart rate at this point is to check your pulse on your wrist, also called the radial pulse.

Blood is always passing through our arteries. However, there is a more forceful push of blood that passes through our arteries with each heartbeat. This creates pressure on the artery walls in what we refer to as the pulse. The pulse reflects the beating of the heart, since the heart beat is what causes the pulse.

As a nurse, you're taking your patients' pulses all the time. You learned during nursing school that there are several places on the body where a pulse can be taken. Just to refresh your memory, the common sites are: carotid, femoral, temporal, brachial, popliteal, pedal, and radial. You almost always take the pulse at the radial site since you are usually working with adults.

Pulse Deficit

Let's now discuss something that might happen while working with a patient. You're in the exam room with your patient, Gina, and taking her pulse. You document that her pulse is 96 beats per minute (bpm). She comments that she feels like her heart is racing. You note that her pulse is toward the high end, but still falls within the normal limits. You aren't sure exactly why she feels as though her heart is racing, but you document her concern in her chart and let her know that Dr. Anderson will be in to see her shortly.

Dr. Anderson begins his exam and notices that Gina's heart is, in fact, beating rather quickly. He places the stethoscope at the apex of the heart to listen closely and determine her heart rate. He counts 120 bpm. He thinks that you may have made a mistake in taking the pulse, so he checks Gina's radial pulse. There, he comes up with 98 bpm.

Dr. Anderson has just discovered that Gina has pulse deficit, which is when there are fewer pulses in the arteries than there are heartbeats. He decides to run a few tests to confirm his suspicion and determine the possible cause.

Causes of Pulse Deficit

Dr. Anderson tells you that he wants to run an EKG (an electrocardiogram) on Gina to determine the cause of her pulse deficit. You think back to your training on pulse deficit and its possible causes. You recall that one possible cause is atrial fibrillation, also called AFib. This is when the atria of the heart beat irregularly and very quickly. There are also times when the atria may partially contract rather than completely contract.

Another possible cause that you recall learning about is atrial flutter. Atrial flutter is when the atria of the heart beat faster than the ventricles of the heart. Are you a little puzzled as to the difference between these two? The difference is that in atrial flutter, the atria have complete heartbeats that are at a steady pace, whereas with atrial fibrillation, the heartbeat is irregular and the atria may not completely contract.

Both atrial fibrillation and atrial flutter can cause pulse deficit because they cause the heart to beat so fast and irregularly that the force of blood out of the heart is sometimes not as strong as normal. If the force of blood from the heart after a heartbeat isn't strong, then that heart beat will not produce a pulse. However, the other heartbeats that are strong enough will still produce a pulse. This creates the difference between the number of heartbeats and pulses in a given minute.

Dr. Anderson finishes reviewing Gina's EKG. He concludes that the cause of her pulse deficit is AFib.

Lesson Summary

Let's briefly go over what we learned in this lesson. The pulse is the feeling of blood as it passes through an artery, pushing on the arterial walls. The pulse reflects the beating of the heart since the heartbeat is what causes the pulse.

Pulse deficit occurs when there are fewer pulses than there are heartbeats. One cause of pulse deficit is atrial fibrillation, abbreviated as AFib, which is when the atria of the heart beat irregularly and very quickly. Another cause is atrial flutter, which is when the atria of the heart beat faster than the ventricles of the heart.

Atrial fibrillation and atrial flutter can cause pulse deficit because they cause the heart to beat so fast, and often irregularly, that the force of blood out of the heart is sometimes not strong enough to create a pulse.

Summary:

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